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Insurance fraud ...
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| StanVoid |
I'm beginning to suspect that my dentist is filing fraudulent claims to my insurance and is very quickly spending up my coverage maximum for the year. Here's the story. Back in February, I went to him for the first time - got a full exam, some x-rays, and about 4 small cavities filled. I got a few insurance claims for that and they seemed to make sense (although I could tell this guy was quite expensive, i.e. he charge my insurance $380 for the full-mouth x-rays he did ... 400 bucks for x-rays, what? is that even normal?)
Thing is though, this guy does not charge ME anything. He only takes $$$ from my insurance and then never contacts me personally for payment out of my own pocket.
Yesterday, though, I receive another claim from my insurance - for dental service back in February! Strange, right? I thought we were all done and fully paid for February, and here he goes running another claim on me! Guess for how much ... $1,250! The claim lists like 10 different teeth that he supposedly did "fillings" work on. Thing is, he already charged my insurance for the 4 fillings he did in February. If you look over all my claims from this guy and count up the number of different teeth that he did filling work on, it'd be over 15. In reality, he touched 4 teeth in my mouth. I am going in to talk with him today about this, and I need some advice on the best way to act about this.
I'm not too quick to call my insurance company yet because this guy hasn't been charging me anything, just the insurance place. So I'm not exactly looking to spend money out of my own pocket here either. But, at the same time, if he's running up my insurance like this i have to do something!
Any advice would help.
COR VERSION: I think my dentist is inflating my insurance claims to rip the most money he can get. Read above for details, sorry. I'm going to confront him today on this, any tips? |
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| occrider |
| Why would you confront him? Just call up the insurance company, tell them what you think is happening, and let them sort it out. I really can't see the upside of confronting people who are potentially committing a crime. |
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| StanVoid |
| quote: | Originally posted by occrider
Why would you confront him? Just call up the insurance company, tell them what you think is happening, and let them sort it out. I really can't see the upside of confronting people who are potentially committing a crime. |
well i happen to have an appointment with him today too, so that makes it .. awkward i guess. I have to go in there anyway, so I'll talk to him first and if things don't go smoothly i'll just walk out before the appointment even begins. |
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| occrider |
| quote: | Originally posted by StanVoid
well i happen to have an appointment with him today too, so that makes it .. awkward i guess. I have to go in there anyway, so I'll talk to him first and if things don't go smoothly i'll just walk out before the appointment even begins. |
Are you looking for drama in your life? Just go get your teeth cleaned, don't say anything, and call the insurance company when you get home. |
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| get nyce |
| quote: | Originally posted by StanVoid
well i happen to have an appointment with him today too, so that makes it .. awkward i guess. I have to go in there anyway, so I'll talk to him first and if things don't go smoothly i'll just walk out before the appointment even begins. |
i take yo in bullets! |
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| Ygrene |
| quote: | Originally posted by occrider
Are you looking for drama in your life? Just go get your teeth cleaned, don't say anything, and call the insurance company when you get home. |
+1
Let the insurance company deal with it. They're the experts, trained to deal with stuff like this, and that's why we pay them. |
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| StanVoid |
| But I'm just afraid if I go directly to the insurance company, they'll bust his ass. And he'll say "ok i'll refund all that extra money back to the insurance but now you owe me out of your own pocket for the %20 of charges that I never asked of you before." |
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| chimera66 |
Maybe it isn't your dentist, but his billing people who mixed up some of your records with someone else's. It would help if you had copies of your bills and inquired why you were charged what you were. Personally I would ask the people at the front desk before confronting your actual dentist. Also I wouldn't exactly walk out because you don't want to waste your time having to make another appointment for a routine cleaning which is done by a dental assistant not your actual dentist. You should figure it out though because you don't want that dentist to use up all your dental coverage...you never know you might get a cavity in November.
Dentists can be quite expensive as well so the cost of your x-rays makes some sense...I've paid around that much for x-rays and spent like $1200 on a root canal. |
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| StanVoid |
| quote: | Originally posted by chimera66
Maybe it isn't your dentist, but his billing people who mixed up some of your records with someone else's. It would help if you had copies of your bills and inquired why you were charged what you were. Personally I would ask the people at the front desk before confronting your actual dentist. Also I wouldn't exactly walk out because you don't want to waste your time having to make another appointment for a routine cleaning which is done by a dental assistant not your actual dentist. You should figure it out though because you don't want that dentist to use up all your dental coverage...you never know you might get a cavity in November.
Dentists can be quite expensive as well so the cost of your x-rays makes some sense...I've paid around that much for x-rays and spent like $1200 on a root canal. |
the cleaning was done by him, as was everything else I've ever had at that place. It's a pretty small joint with a front-desk girl and the dentist in the back. I called them earlier today regarding this, and she just handed the phone over to the dentist and he basically said to come in and just discuss this when I have my appointment - because "it's easier to sort out these kinds of things in person where we can see all the papers in front of us together" ....
and yeah...new york dental is F%@^ING EXPENSIVE. |
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| Ygrene |
| quote: | Originally posted by StanVoid
But I'm just afraid if I go directly to the insurance company, they'll bust his ass. And he'll say "ok i'll refund all that extra money back to the insurance but now you owe me out of your own pocket for the %20 of charges that I never asked of you before." |
LOLOLOLOLOL
So you are worried the dentist will find out you are trying to scam him?!
Honesty is the best policy. Tell your insurance co what's going on and pay your bill. One way or the other, it all has chance to come back to you, |
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| XaNaX |
| quote: | Originally posted by StanVoid
But I'm just afraid if I go directly to the insurance company, they'll bust his ass. And he'll say "ok i'll refund all that extra money back to the insurance but now you owe me out of your own pocket for the %20 of charges that I never asked of you before." |
So let me get this straight, you have not been paying anything to this guy so you want to make issue of it and maybe be on the hook for 20% of a several thousand dollar dental bill? Makes sense to me man. |
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| chimera66 |
| quote: | Originally posted by StanVoid
the cleaning was done by him, as was everything else I've ever had at that place. It's a pretty small joint with a front-desk girl and the dentist in the back. I called them earlier today regarding this, and she just handed the phone over to the dentist and he basically said to come in and just discuss this when I have my appointment - because "it's easier to sort out these kinds of things in person where we can see all the papers in front of us together" ....
and yeah...new york dental is F%@^ING EXPENSIVE. |
That's kind of odd that he does the little stuff and that he wouldn't give you a straight answer earlier. I would kindly ask about the charges and make sure that today's visit is covered by your insurance. He can't exactly fight you about fillings he never did because you can point out whether they exist or not. If you think he's screwing you start going to someone else because after a while who knows he might start making up cavities. |
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